Case Report
Copyright ©The Author(s) 2018. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Oncol. Mar 15, 2018; 10(3): 91-95
Published online Mar 15, 2018. doi: 10.4251/wjgo.v10.i3.91
Case of pancreatic metastasis from colon cancer in which cell block using the Trefle® endoscopic scraper enables differential diagnosis from pancreatic cancer
Akihisa Kato, Itaru Naitoh, Hiroyuki Kato, Kazuki Hayashi, Katsuyuki Miyabe, Michihiro Yoshida, Yasuki Hori, Makoto Natsume, Naruomi Jinno, Takeshi Yanagita, Shuji Takiguchi, Satoru Takahashi, Takashi Joh
Akihisa Kato, Itaru Naitoh, Kazuki Hayashi, Katsuyuki Miyabe, Michihiro Yoshida, Yasuki Hori, Makoto Natsume, Naruomi Jinno, Takashi Joh, Department of Gastroenterology and Metabolism, Nagoya City University Graduate School of Medical Sciences, Nagoya 467-8601, Japan
Hiroyuki Kato, Satoru Takahashi, Department of Experimental Pathology and Tumor Biology, Nagoya City University Graduate School of Medical Sciences, Nagoya 467-8601, Japan
Takeshi Yanagita, Shuji Takiguchi, Department of Gastroenterological Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya 467-8601, Japan
Author contributions: Kato A and Naitoh I mainly designed this concept and drafted the article; Miyabe K, Yoshida M, Hori Y, Natsume M, Jinno N and Yanagita T performed the treatment for the patient and provided data involved in clinical course; Kato H and Takahashi S performed histological evaluation and provided data involved in immunohistochemistry; Hayashi K and Takiguchi S revised the article for important intellectual content; Joh T gave a final approval of the article.
Informed consent statement: Written informed consent was obtained from the patient.
Conflict-of-interest statement: No potential conflicts of interest relevant to this article were reported.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Itaru Naitoh, MD, PhD, Assistant Professor, Department of Gastroenterology and Metabolism, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya 467-8601, Japan. inaito@med.nagoya-cu.ac.jp
Telephone: +81-52-8538211 Fax: +81-52-8520952
Received: December 5, 2017
Peer-review started: December 5, 2017
First decision: January 3, 2018
Revised: January 9, 2018
Accepted: February 3, 2018
Article in press: February 3, 2018
Published online: March 15, 2018
ARTICLE HIGHLIGHTS
Case characteristics

The patient underwent resection for rectal adenocarcinoma presented metastases to the liver and lung with epigastric pain and jaundice.

Clinical diagnosis

The patient was diagnosed with obstructive jaundice.

Differential diagnosis

Primary pancreatobiliary carcinoma or pancreatic metastasis from colon cancer.

Laboratory diagnosis

Laboratory evaluation revealed the findings of obstructive jaundice.

Imaging diagnosis

The patient was diagnosed with obstructive jaundice due to primary pancreatic ductal adenocarcinoma.

Pathological diagnosis

Immunohistochemical findings of the cell block sections obtained using the Trefle® endoscopic scraper were consistent with those of previous resected specimens, confirming the final diagnosis of pancreatic metastasis from colon cancer.

Treatment

A covered self-expanding metal stent was inserted to resolve the symptoms and establish biliary drainage and the third-line chemotherapy regimen for colon cancer was administered.

Related reports

There have been few reports dealing with the combination of a scraper Trefle® and cell block method for histocytological diagnosis of malignant biliary strictures.

Experiences and lessons

The combination of the cell block technique and the Trefle® device shows promise for diagnosis of biliary strictures as it is as easy as conventional brush cytology.